Twyford Practice

Updated 4 May 2017

Twyford Practice provides GP services to 12,800 patients in a semi-rural area of Berkshire around the large village of Twyford and partially bounded by the River Thames and the M4 motorway. The practice serves an area with an overall low level of deprivation. Ethnicity based on demographics collected in the 2011 census shows the population of the surrounding area is predominantly White

British. There is an annual patient list turnover of 10%, and a higher number of patients aged five to 15 and 35 to 54.

The practice has seven GP partners, four female and three male, and two female salaried GPs, equivalent in total to just under six whole time GPs. There are four practice nurses, equivalent to 2.75 whole time, and two healthcare assistants. It also has a dispensary which can provide pharmaceutical services to patients who live more than one mile (1.6km) from their nearest pharmacy premises. Two dispensers currently provide the services to 9% of patients. The practice provides a delivery service for dispensed to patients’ homes when appropriate.

Services are provided to a local nursing home, a rehabilitation home for the elderly recovering from operations, a care home for children with emotional issues, a chronic mental health unit and a residential rehabilitation facility for patients with substance abuse issues. Many former residents of this facility settle in the area after completing or leaving the programme and as a result, the practice has a higher than average number of patients with current or previous substance misuse issues.

Accommodation is provided on site for a number of additional services on a regular or occasional basis, including breast and aortic aneurism screening, smoking cessation, audiology testing, counselling and physiotherapy. The practice also hosts medical students on six week placements and for short taster experiences.

The practice is open from 8am to 6.30pm Monday to Friday, with additional consultations available on Saturday mornings from 8.30am to 11.30am. Telephone consultations are available from 7.30am and at 6.30pm on weekdays. The dispensary is open from 9am to 12.30pm and 2pm to 5pm Monday to Friday.

The out of hours service is provided by WestCall and is accessed by calling NHS 111. Advice on how to access the out of hours service is contained in the practice leaflet, on the patient website and on a recorded message when the surgery is closed.

Services are delivered from:

• Twyford Surgery, Loddon Hall Road, Twyford, Berkshire RG10 9JA

Updated 4 May 2017

Letter from the Chief Inspector of General Practice

At our previous comprehensive inspection at Twyford Practice in Twyford, Berkshire on 31 August 2016 we found a breach of regulations relating to the provision of safe services. The overall rating for the practice was good. Specifically, Twyford Practice was rated requires improvement for providing safe services and good for the provision of effective, caring, responsive and well-led services. The full comprehensive report on the August 2016 inspection can be found by selecting the ‘all reports’ link for Twyford Practice on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 11 April 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulations that we identified in our previous inspection in August 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

We found the practice had made improvements since our last inspection. Using information provided by the practice we found the practice was now meeting the regulations that had previously been breached. We have amended the rating for this practice to reflect these changes. The practice is now rated good for the provision of safe, effective, caring, responsive and well led services.

Our key findings were as follows:

• The practice had assessed, monitored and mitigated risks relating to the storage of test results, topical medicines and prescriptions within a previously unsecure area of the practice. This included a new process whereby all completed and signed prescriptions were taken directly to the dispensary.

• The practice had taken steps to increase the number of identified patients with caring responsibilities within the practice population. In April 2017, the practice patient population was 12,800. The practice had identified 241 patients, who were also a carer; this was an increase from 120 identified carers at the August 2016 inspection and amounted to approximately 1.8% of the practice list. A designated area within the practice waiting area and on the practice website signposted patients with caring responsibilities to the various avenues of support available from the practice, charities and voluntary organisations where appropriate.

• The practice had continued work in an attempt to improve patient satisfaction regarding access. We saw the practice was taking appropriate action with a view to monitor the patient experience. The practice had introduced additional telephone lines, a dedicated emergency number and a separate phone line for outgoing calls. Changes had been made to the receptionist’s rota to ensure that additional receptionist’s were available at the start of every day. Patients were also being encouraged to make bookings online rather than telephone for routine appointments. Furthermore, the practice had introduced a new system and supporting correspondence whereby follow up appointments requested by a GP could be booked directly by the reception team.
• The practice had reviewed accessibility expectations for patients with disabilities, those using wheelchairs and parents with children in pushchairs. As a result, adaptions had been made and the practice had further plans for the installation of automatic doors with wall mounted access buttons.
• Appropriate appraisal arrangements were now in place, appraisals had been completed and there was evidence of performance monitoring and identification of personal and professional development.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 12 October 2016

The practice is rated as good for the care of people with long-term conditions.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• Performance for some diabetes related indicators was below the clinical commissioning group (CCG) and national average, with 70% of patients with diabetes achieving a target blood level of 64mmol or below compared to the CCG average of 74% and national average of 78%. The practice was responding to this by implementing the Diabetes UK Year of Care programme to improve patients’ self-management of their condition.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

• Patients with long-term conditions were screened for depression, and provided with appropriate support.

• The practice liaised with community heart failure and chronic obstructive pulmonary disease (COPD) nurses and the community matron to support patients who struggled to attend the surgery.

Updated 12 October 2016

The practice is rated as good for the care of families, children and young people.

• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances. Immunisation rates were in line with national averages for children aged up to five, but slightly below average for under twos.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

• 86% of female patients aged 25 to 64 had received a cervical screening test in the preceding five years, compared to a CCG average of 84% and a national average of 82%.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• We saw positive examples of joint working with health visitors.

• Safeguarding cases were discussed at the practice’s monthly primary health care team meeting and there was regular liaison with the health visitor locality team, which was based on site.

• Counselling services for teenagers and young adults were available on site.

Updated 12 October 2016

The practice is rated as good for the care of older people.

• It offered proactive, personalised care to meet the needs of the older people in its population.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. GPs undertook weekly ward rounds at the local nursing home and rehabilitation home for elderly people recovering from operations.

• Close links were maintained with the community matron and district nurses who had their offices on site and were welcomed to attend the practice team’s mid-morning coffee breaks to discuss cases.

• Flu clinics were supported by local organisations working with the elderly to create a community social event.

• Patients with a history of falls were referred for assessment and to the local Steady Steps fall prevention project when appropriate.

Updated 12 October 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).

• The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.

• It was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.

• Breast and aortic aneurism screening, smoking cessation, audiology testing, counselling and physiotherapy was available at the surgery to improve patient access.

• Twice-monthly Saturday morning surgeries and early morning and late evening telephone consultations were available for those who found it difficult to attend during usual opening hours.

Updated 12 October 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

• 99% of patients diagnosed with schizophrenia, bipolar affective disorder and other psychoses had their care reviewed in a face to face meeting in the last 12 months, which is above the CCG average of 93% and the national average of 88%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

• Advance care planning was carried out for patients with dementia.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• There was a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 12 October 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.

• Patients with a learning disability were offered longer appointments.

• There was regular work with other health care professionals in the case management of vulnerable patients.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

• Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.

• The practice provided GP services for residents of a local drug rehabilitation centre, many of whom settled in the area after completing or leaving the programme. As a result, the surgery had a high number of patients with current or previous substance misuse issues. It engaged with the local drug and alcohol recovery service to provide drug maintenance and addiction therapy support.

• GP services were also provided to a local sheltered accommodation unit for vulnerable adults and a residential home for children with emotional difficulties.